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General NPI Number Information
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NPI Number | 1003095605
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Entity Type | Organization
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Legal Business Name | GRAND TRAVERSE ORAL SURGERY, P.C.
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Dates
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Enumeration Date | 10/31/2007
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Last Update Date | 03/19/2008
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Provider Practice Location Address
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Address Line | 12776 S WEST BAY SHORE DR
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City | TRAVERSE CITY
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State | MI
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Zip | 49684-5451
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Country | US
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Telephone | 231-946-3512
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Fax | 231-946-1908
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Provider Business Mailing Address
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Address Line | 12776 S WEST BAY SHORE DR
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City | TRAVERSE CITY
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State | MI
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Zip | 49684-5451
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Country | US
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Telephone | 231-946-3512
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Fax | 231-946-1908
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | SUSAN J. SCHLUETER
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Credential |
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Telephone | 231-946-3512
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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